Warm autoimmune hemolytic anemia (warm AIHA) is a rare type of anemia in which the immune system mistakenly attacks and destroys red blood cells. Warm AIHA can happen at any age, and it affects about 1 to 3 people out of every 100,000 each year.

Warm AIHA happens when your immune system makes autoantibodies — proteins that mistakenly target your own cells — that destroy red blood cells faster than your body can replace them. This destruction is called hemolysis. The condition is called “warm” AIHA because these autoantibodies are active at normal body temperature, unlike those involved in cold AIHA, which react at lower temperatures.

For many people, warm AIHA responds well to treatment. Several treatments are available, and newer options continue to emerge. Here’s a look at six of the main approaches doctors use to treat warm AIHA.

🗳️ Before you were diagnosed with wAIHA, which symptoms had the biggest impact on your daily life?

Fatigue

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Shortness of breath

Racing heart

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Corticosteroids, most often prednisone, are the standard first-line therapy for warm AIHA. They calm the immune system and reduce the destruction of red blood cells. Research suggests corticosteroids help about 70 percent to 85 percent of people see meaningful improvement in their blood counts, usually within a few weeks of starting treatment.

However, responding doesn’t always mean permanent remission. Doctors typically taper the dose slowly, often over several months. Tapering corticosteroids too quickly may increase the risk that warm AIHA will come back.

Corticosteroids alone aren’t always enough, and some people may develop side effects or have trouble lowering the dose without their warm AIHA returning. In these cases, your care team may talk with you about another treatment, such as rituximab.

Rituximab is increasingly a preferred second-line treatment for warm AIHA when corticosteroids alone don’t fully work. This medication targets B cells, white blood cells involved in making antibodies, which can lead to longer-lasting remission than corticosteroids alone. Studies suggest around 80 percent of people respond, often within a few weeks of their first dose.

For people with severe warm AIHA, doctors sometimes add rituximab to corticosteroids from the start, rather than waiting to see if corticosteroids work on their own. Research suggests people treated with both are more likely to stay in remission over the long term than those treated only with corticosteroids.

If warm AIHA returns after rituximab, some people may respond to another round of treatment. That means rituximab may be an option your doctor can return to over time.

Splenectomy is surgery to remove the spleen, an organ where many antibody-coated red blood cells are destroyed in warm AIHA. For people who haven’t responded well to other treatments, removing the spleen can lead to long-term remission.

Doctors typically reserve splenectomy for later in the treatment plan, after corticosteroids and rituximab haven’t controlled the condition well enough. The procedure is used less often today than in the past, largely because rituximab and other treatments may work well without surgery.

Like any operation, splenectomy carries risks, including a higher long-term risk of certain infections, since the spleen normally helps fight some types of bacteria. Doctors usually recommend certain vaccines before surgery to help lower this risk. Your doctor may also recommend other steps to help prevent infections after surgery, depending on your situation.

When corticosteroids and rituximab haven’t fully controlled warm AIHA, doctors may turn to other steroid-sparing options, including immunosuppressive drugs and danazol. These treatments may help reduce the need for corticosteroids.

Common immunosuppressive drugs include azathioprine, mycophenolate mofetil, cyclosporine, and cyclophosphamide. Doctors may use these medicines to help reduce the need for high doses of corticosteroids over the long term.

Danazol is a synthetic steroid with mild effects that doctors sometimes use alongside corticosteroids. Research suggests it tends to work best combined with other treatments rather than on its own, and it’s used less often today than it once was.

These options typically take weeks to start showing effects. Your care team will monitor you for side effects, which vary depending on the medicine. These treatments are generally used along with other therapies rather than on their own.

Alongside treatments that target the immune system, supportive care helps manage warm AIHA while other therapies take effect. Folic acid supplementation is one example. Active hemolysis can increase the body’s need for folate, so supplementation supports red blood cell production.

Your care team may also check your vitamin B12 and iron levels, since low levels of either can make anemia harder to manage. Eating a balanced diet and staying well hydrated can support your overall energy levels, although these steps work alongside medical treatment rather than replacing it.

If your anemia becomes severe, your doctor may recommend a blood transfusion to quickly increase the number of red blood cells in your blood. Warm AIHA antibodies can make it harder to find compatible donor blood. Your care team will perform testing to find the safest available blood for transfusion.

Intravenous immunoglobulin (IVIG) is another option doctors sometimes use in severe cases. Research suggests IVIG helps only some people, and the benefits don’t tend to last long.

Recombinant erythropoietin, a lab-made version of a hormone that stimulates red blood cell production in the bone marrow, can also help some people. It may be considered when the bone marrow isn’t making enough new red blood cells to keep up with those being destroyed.

Knowing the warning signs of severe anemia can help you get care quickly when needed. If you or someone you’re caring for develops chest pain, severe shortness of breath, a racing heartbeat, or fainting, seek medical care right away.

A new generation of targeted therapies is expanding treatment options for warm AIHA, especially for people whose condition keeps coming back despite standard treatment. These drugs target more specific parts of the disease process than older immunosuppressants do.

In August 2026, the FDA approved nipocalimab-aahu (Imaavy) as the first drug specifically for warm AIHA. It’s approved for people ages 12 and older who have been treated with corticosteroids. Nipocalimab-aahu is given by infusion and works by blocking a receptor that normally protects antibodies from breaking down, helping the body clear harmful autoantibodies faster.

Other drug classes are also being studied for warm AIHA. These include Syk inhibitors such as fostamatinib and Bruton’s tyrosine kinase inhibitors such as rilzabrutinib, which interrupt immune signals that drive red blood cell destruction.

Complement inhibitors are another area of research. They target a different part of the immune system that can contribute to hemolysis. These investigational approaches may eventually offer more choices for people with warm AIHA that’s difficult to treat.

Partnering With Your Care Team

Multiple treatment options are available for warm AIHA, and a combination of treatments may sometimes be needed. By working closely with your healthcare team, you can find a treatment plan that works for you, although this may take some trial and error.

Whether you are just starting treatment or have been managing warm AIHA for a while, consider keeping a simple log of your symptoms and side effects to share at your appointments. Writing down questions about your treatment or signs that warm AIHA may be returning can also help you make the most of your visits.

Sharing this information with your care team can help them tailor your treatment plan to your needs.